Scanning in the supply room

[elizabeast7]

Greetings!

Our hospital has supply rooms set up for each unit with a scanning system. We are routinely not scanning, and thus not charging for supplies.

Hypothetically, staff will sign into the computer, select the patient, scan the item, hit save and log out of their ID.

This is not happening.

Any suggestions? How does your facility track supplies?

[applesxoranges, BSN, RN]

I think ours gets charged by documenting it.

[dream'n, BSN, RN]

I have no idea how my hospital receives reimbursement for supplies. We don't scan supplies of any kind. On top of all I have to do as a nurse, if I had to scan every set of IV tubing, etc., I would go crazy. Personally I'm sick of hearing about hospital billing, charges, reimbursement, and budgeting. I'm a nurse not a bean counter. Therefore, I don't consider financials as my job or my problem; I'm not management or administration. I already have enough to do.

[Mavrick, BSN, RN]

We have the worse possible EHR because it is built by a supply company and retro-fitted to be a nursing record. In order to close out a chart, the supplies must be verified and you are forced to go to the supply checkout. A list of common supplies is auto populated and specialty items will be listed according to the surgical case being done, such as a suction canister and Yankauer for oral cases. I routinely check the O2 nasal cannula and SCD box and other easy stuff if it's listed. If I have to "search" more than once, because it's listed as some goofy item (bag, ice, lrg) fageddaboudit.

When I pull stuff from the supply room I tell myself to remember it later and sometimes I do.

Our manager is very tricky and will post an audit of lost supply charges and what they "would have bought" (staff refrigerator, espresso machine, more-better rolling chairs, bladder scanner, pizza party, etc)

[nurseypants123]

I hate doing charges. I never took a class in nursing school on billing and reimbursement. Because that's not my job. We've done charges on paper, using stickers and now we have a scanner. The scanner is cumbersome and rarely works. It takes 5 or 6 steps to scan a single item. No thanks. I don't even bother. Our omnicell is too small to put extra items in, but it's probably the best way of ensuring that things are charged for. Because that makes it part of the process of getting the item, instead of adding extra steps.

[iluvivt, BSN, RN]

The reality in life is that things cost money and it's true in nursing and medicine.So it is part of your job and you will have less nurses or equipment if you fail to realize this and accept it! Have each nurse save all the packages they use and have them put the patient initials on each item.At the end of the shift nurse A has ten empty packages and should have ten sign outs...if they do not then can go and charge for them at that time.The charge nurse will need to check with each nurse.You can also have each nurse have a charge worksheet and as they use things they write them down on the worksheet. That way it does not interfere with timely patient care and they can charge everything at once.I used to do that way for IV catheters. I would sit down at the end of my shift and input all my charges. I would also have a monthly incentive for those that are 100 percent complaint. They each turn in a sheet with a check mark on the item once it has been charged.All those compliant get entered in to get something. A free meal,a gift certificate or something like that until it becomes a habit for all.

[dishes, BSN, RN]

We do not scan supplies. Pts. are charged for procedures and that covers the cost of the supplies used for that procedure. The rest (alcohol swabs, IV tubing, and so on) is just part of the cost of being in the hospital.

This practice is the one that hospitals should adopt, the results will be more consistent and managers will not need to resort to coercion or carrot and stick tactics.

[RNperdiem, RN]

It is a combination where I work. Expensive items like chest tube trays, triple lumen catheter kits, swan monitoring lines are in a tower pyxis and have to be taken out under a particular patient. Charge done with minimal extra work.

There is a flat room rate for the basics-bedpans, urinals, IV tubing etc.

For meds there is a bedside computer and scanner. The scanners are kept in good working order so we can scan meds at the bedside, capture charges with little extra work.

To increase compliance, make it easy.

I remember when increasing hand hygiene became a priority and many places realized that compliance was going to be difficult when there were only a couple of inconveniently located sinks on a unit. Alcohol hand sanitizers placed right outside and inside the room helped make this easier.

[vampiregirl, BSN, RN]

It would seem that the logical solution would be to capture charges based on charting.

Different environment, but this is how billing is done for the EMS service where I work part time. Works well for us, I've always wondered why it isn't the same for nursing.

[dishes, BSN, RN]

Sometimes the managers hands are tied by people higher up the food chain

Use of coercion from senior administrators carries on down and normalizes it in the workplace environment, the more prevalent workplace coercion is, the more likely it will be used against patients.

[dream'n, BSN, RN]

The reality in life is that things cost money and it's true in nursing and medicine.So it is part of your job and you will have less nurses or equipment if you fail to realize this and accept it! Have each nurse save all the packages they use and have them put the patient initials on each item.At the end of the shift nurse A has ten empty packages and should have ten sign outs...if they do not then can go and charge for them at that time.The charge nurse will need to check with each nurse.You can also have each nurse have a charge worksheet and as they use things they write them down on the worksheet. That way it does not interfere with timely patient care and they can charge everything at once.I used to do that way for IV catheters. I would sit down at the end of my shift and input all my charges. I would also have a monthly incentive for those that are 100 percent complaint. They each turn in a sheet with a check mark on the item once it has been charged.All those compliant get entered in to get something. A free meal,a gift certificate or something like that until it becomes a habit for all.

Of course things cost money, but I will not be roped into doing another non-nursing task. I DO NOT have the time to worry about financial capture of supplies. As for staying after shift to scan all these items, you do realize that I'm already staying an hour to two late every shift finishing patient care and filling out tedious forms that some brainchild in administration has decided "to trial" in place of hiring enough staff for good nursing care ratios. Everything that is too troublesome for other departments to handle is always shifted to nursing. If this reimbursement issue is so important, then hire someone to do it, or better yet have management handle the scanning. If my employer tried this I would put my foot down, which sounds like what is happening with the OPs floor already. The nurses just aren't and won't do it.

All hospitals have coders, billers, chart reviewers, and a finance department. This is their problem to handle. Or give the responsibility to the supply department.

Maybe I'm just a b****, but honestly the hospital's financial success makes no difference to me. Not what I'm employed to worry about. I not the one getting a bonus. If the hospital can't stay solvent, I'll just move on to another. I'm a nurse and give great nursing care, that's what my job is.

[elizabeast7, ADN, BSN, MSN]

I like the idea of putting the larger items in the Pyxis. I think that would work best for our unit. We've joked about putting a camera and mic in there and having the HUC watch them. Then she could be like "KAREN, I KNOW THAT'S YOUR ASS. YOU BETTER SCAN THOSE IV LINES." We actually have a wing that has been redesigned to be offices and probably has security cameras/monitors we can use.

I appreciate all the suggestions! We are going to discuss them at our next staff meeting. I don't think the noncompliance is from people "putting their foot down". When we discuss it as a unit, most are expressing that they simply forget to go back and scan, or that they just don't think about it. It's not muscle memory and thus is not being done. Nobody is opposed to it, we just aren't using the current system. The items are in bins with barcodes on them. We literally just have to select a patient name from a touch screen, scan the corresponding bins, and hit save. Even when I'm not in a hurry, I grab my items and think "Oh, I'll come back later." But I rarely do. There's no particular reason why - it just slips my mind.

Personally, despite the fact that I don't charge everything I'm supposed to, I understand and can appreciate the purpose. This post was about finding a better way, an easier way, to document our product use. I wanted to now how other facilities do this. I can't be so nonchalant about my hospital's future. I love my job and my community. My hospital is the only medical access for many in the rural area I live in. It's success means a lot to me and is literally life or death for many of my patients as they could not travel to the next closest facility (over an hr away from where I am, probably a few hrs from many of my patients) to receive care. As a staff nurse, I feel compelled to be involved and proactive in the way my hospital is run and how decisions are made. It directly impacts my patients, my work and my life. There is no "us" vs "them" mentality for me. We should be working together, as an interdepartmental team, to find a solution that provides the best possible care. Perhaps that does mean having someone from materials management monitor the supply room and it's outgoing items, but that should be a decision that is made because it's the most suitable for all involved.

[iluvivt, BSN, RN]

That's a good idea. ..ask for more help and I know things get shifted to nursing and I have 34 yrs of it! The reality is if you don't fix the problem you will hearing about it for a long time.Sure it's not fair, but it is the way it it..you use the supplies...you all need to faithfully charge for them!